Tricare presents plan for re-enrolling some in Prime

Apr. 15, 2014 - 06:00AM
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A veteran patient recieves a vaccination. Tricare announced Tuesday its plans for reinstating thousands of beneficiaries who lost eligibility for Tricare Prime last October. (Stephanie McCrobie / U.S. Navy)

Tricare announced Tuesday its plans for reinstating thousands of beneficiaries who lost eligibility for Tricare Prime last October, but by law, not all who were booted off Prime will be able to re-enroll.

The fiscal 2014 National Defense Authorization Act required the Defense Department to give affected beneficiaries a one-time option to continue in Tricare Prime.

And in accordance with the law, Tricare plans to send letters starting April 28 to those eligible to re-enroll. Beneficiaries will have until June 30 to make their decision.

But while roughly 177,000 Tricare Prime beneficiaries ó mainly retirees and family members ó were disenrolled from the Pentagonís health maintenance organization-style program when DoD reduced the availability of Tricare Prime to locations within 40 miles of an active base, fewer than half will receive letters to re-enroll.

According to Tricare, about 35,000 beneficiaries received waivers or moved to another Prime service area after they were disenrolled and no longer are affected.

But the law passed by Congress in December also stipulated that the one-time opt-in apply only to beneficiaries who live in a ZIP code that was a designated Prime service area as of Sept. 30, 2013, and they live within 100 miles of a current or former military medical treatment facility.

That second condition prevents 66,000 beneficiaries who once had Prime in areas where the Tricare contract managers offered it but there were no bases, including much of the Tricare South region and cities like Pittsburgh and Minneapolis, from opting back in.

Tricare officials said about 76,000 beneficiaries will get letters informing them of their eligibility and information on how to get back into Prime. They also will be required to see a primary care doctor who practices within 40 miles of the present base, should they choose to re-enroll.

Those who donít want to return to Prime will not have to take any action. They will remain on Tricare Standard.

To re-enroll, the beneficiary must submit an enrollment form and waive drive time standards. Managed care contractors will help beneficiaries find available PCMs, according to Tricare.